WO2020239696A1 - Administration améliorée de glycylcyclines par inhalation - Google Patents

Administration améliorée de glycylcyclines par inhalation Download PDF

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Publication number
WO2020239696A1
WO2020239696A1 PCT/EP2020/064444 EP2020064444W WO2020239696A1 WO 2020239696 A1 WO2020239696 A1 WO 2020239696A1 EP 2020064444 W EP2020064444 W EP 2020064444W WO 2020239696 A1 WO2020239696 A1 WO 2020239696A1
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Prior art keywords
glycylcycline
use according
subject
abscessus
infection
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PCT/EP2020/064444
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English (en)
Inventor
Jakobus VAN INGEN
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Stichting Katholieke Universiteit
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Priority to US17/611,912 priority Critical patent/US20220233555A1/en
Priority to EP20729969.4A priority patent/EP3976050A1/fr
Publication of WO2020239696A1 publication Critical patent/WO2020239696A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00—Medicinal preparations containing organic active ingredients
    • A61K31/65—Tetracyclines
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/007—Pulmonary tract; Aromatherapy
    • A61K9/0073—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/007—Pulmonary tract; Aromatherapy
    • A61K9/0073—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy
    • A61K9/0075—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy for inhalation via a dry powder inhaler [DPI], e.g. comprising micronized drug mixed with lactose carrier particles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00—Medicinal preparations characterised by special physical form
    • A61K9/0012—Galenical forms characterised by the site of application
    • A61K9/007—Pulmonary tract; Aromatherapy
    • A61K9/0073—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy
    • A61K9/0078—Sprays or powders for inhalation; Aerolised or nebulised preparations generated by other means than thermal energy for inhalation via a nebulizer such as a jet nebulizer, ultrasonic nebulizer, e.g. in the form of aqueous drug solutions or dispersions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P31/00—Antiinfectives, i.e. antibiotics, antiseptics, chemotherapeutics
    • A61P31/04—Antibacterial agents

Definitions

  • the present invention relates to a new administration regime for glycylcyclines. Inhalation of these antibiotics was found to potently treat infection by Mycobacterium microbes such as Mycobacterium abscessus.
  • Glycylcyclines a relatively new group of antibacterial agents, have the central four-ring carbocyclic skeleton present in the tetracyclines that is necessary for antibacterial activity.
  • substitution of an N-alkyl-glycylamido group on the D ring at the 9th position facilitates the broader spectrum of activity (Sum et al., J. Med. Chem. 1994, 37, 184-188). This additionally creates the ability to overcome tetracycline resistance mechanisms (Pankey, J. Antimicrob.
  • glycylcyclines bind to the high-affinity tetracycline ribosomal binding site and evade Tet(M)- and Tet(0)-mediated ribosomal protection (Bergeron et al., Antimicrob. Agents Chemother., 1996, 40(9): 2226-2228).
  • An example of a glycylcycline is tigecycline, which has a 9-fe/ -butyl-glycylamido side chain on the tetracycle, wherein the tetracycle in this case is minocycline.
  • Other examples are eravacycline and DMG-DMDOT. Synthesis of glycylcyclines is known from EP0582790 and US5494903.
  • Glycylcyclines have a similar mechanism of antibiotic action as tetracyclines. They block protein synthesis, preventing bacterial reproduction. Both classes of antibiotics bind to the 30S ribosomal subunit to prevent the amino-acyl tRNA from binding to the A site of the ribosome. Glycylcyclines bind more effectively than tetracyclines. Glycylcyclines are active against other resistant pathogens including methicillin-resistant staphylococci, penicillin-resistant Streptococcus pneumoniae, and vancomycin-resistant enterococci. (Zhanel et al., Drugs (2004) 64: 63, doi.org/10.2165/00003495-200464010-00005)
  • Tigecycline is the only glycylcycline that is on the market for pharmaceutical use. It is only available as an injectable formulation, unlike tetracyclines, which can be available in oral dosage forms. Tigecycline has a significantly larger volume of distribution (>10 L/kg) than tetracyclines (range of 0.14 to 1 .6 L/kg). Protein binding is approximately 68%. Studies in rats using radiolabelled tigecycline demonstrated good penetration into tissues. Tigecycline has a half-life of 36 hours in humans, and not more than 15% of tigecycline is excreted unchanged in the urine. The pharmacokinetics of tigecycline are not markedly influenced by patient gender or age.
  • tigecycline An important characteristic of tigecycline is that while it is safe, it leads to various side effects, particularly at doses required to achieve clinically relevant effects as known in the art.
  • Common side effects of tigecycline include nausea and vomiting.
  • Muralidharan Antimicrob. Agents Chemother., 2005, 49 (1): 220-229. doi:10.1 128/aac.49.1 .220- 229.2005
  • gastrointestinal adverse events were found to be dose limiting at 300 mg.
  • the most common adverse events were nausea (33 of 68 tigecycline recipients [48.5%]) and vomiting (20 of 68 tigecycline recipients [29.4%]).
  • CN103044281 discloses that improved purity of tigecycline can decrease the incidence of these side effects, but not eliminate it.
  • WO201 1073002 describes dry formulations for inhalation comprising particles of aminoglycoside antibiotics coated with magnesium stearate, for treating cystic fibrosis patients colonized with Pseudomonas aeruginosa.
  • Mycobacterial infections are known to be difficult to treat.
  • the organisms are hardy because of their cell wall, which is neither truly Gram negative nor positive. Also, they are naturally resistant to a number of antibiotics that disrupt cell-wall biosynthesis, such as penicillin. Due to this particular cell wall, mycobacteria can survive long exposure to acids, alkalis, detergents, oxidative bursts, lysis by complement, and many antibiotics.
  • mycobacteria are susceptible to the antibiotics clarithromycin and rifamycins such as amikacin, but antibiotic-resistant strains have emerged.
  • Ferro et al. Antimicrob. Agents Chemother., 60:2895-2900. doi: 10.1 128/AAC.031 12-15
  • Ferro et al. describe a dose-response study in a hollow-fiber system model of pulmonary M. abscessus infection, using the injectable formulation.
  • the optimal tigecycline clinical dose was identified as 200 mg/day. This dose exhibited a short-term inhibitory effect on M. abscessus, achieving 1 -log kill.
  • the invention provides a glycylcycline for use in the treatment of a subject infected with gram positive bacteria, wherein the glycylcycline is administered by inhalation.
  • the subject is infected with mycobacteria, preferably with nontuberculous mycobacteria.
  • the subject is infected with a mycobacterium of a clade selected from the group consisting of M. abscessus, M. avium complex, M. tuberculosis complex, M.
  • the subject is infected with a mycobacterium of the clade M. abscessus, or a subspecies thereof such as M. abscessus subspecies abscessus, M. abscessus subspecies bolletii or M. abscessus subspecies massiliense.
  • the infection in the subject is a pulmonary infection.
  • the subject is suffering from a disease selected from the group consisting of cystic fibrosis, non-cystic fibrosis bronchiectasis, pneumonia, chronic pulmonary obstructive disease, nontuberculous mycobacteria (NTM) pulmonary infection, and tuberculosis, preferably cystic fibrosis.
  • a disease selected from the group consisting of cystic fibrosis, non-cystic fibrosis bronchiectasis, pneumonia, chronic pulmonary obstructive disease, nontuberculous mycobacteria (NTM) pulmonary infection, and tuberculosis, preferably cystic fibrosis.
  • the glycylcycline is tigecycline.
  • less than 400 mg/day is administered to a subject, more preferably less than 200 mg/day, even more preferably less than 100 mg/day.
  • the treatment has at least 2 log kill efficacy.
  • the glycylcycline is formulated as an inhalable formulation that further comprises a pharmaceutically acceptable excipient such as a stearate.
  • the inhalable formulation comprises at least 80 wt.-% of glycylcycline.
  • the inhalable formulation comprises glycylcycline microparticles having a volume diameter lower than 15 pm, preferably lower than 10 pm.
  • the glycylcycline is formulated for nebulisation or for dry powder inhalation, preferably for nebulisation.
  • the administration of the glycylcycline is part of a multi-drug regimen for the treatment of the bacterial infection.
  • a method of treating infection with gram positive bacteria in a subject comprising the step of administering glycylcycline to the subject via inhalation.
  • the invention provides a glycylcycline for use in the treatment of a subject infected with gram positive bacteria, wherein the glycylcycline is administered by inhalation.
  • a glycylcycline is referred to hereinafter as a glycylcycline for use according to the invention.
  • the subject is a non-human subject.
  • the subject is a human subject.
  • the subject is a subject in need of treatment or at risk of infection, most preferably in need of treatment. Need of treatment can be need to cure an infection, but it can also be prophylactic treatment.
  • treatment is primary prophylactic treatment for the prevention of disease.
  • a subject is a young subject, preferably a juvenile subject, more preferably a newborn subject.
  • a subject is elderly. An elderly subject is preferably over 50 years of age, more preferably over 60, even more preferably over 65, more preferably still over 70, most preferably over 75.
  • Gram positive bacteria are widely known in the art. Several genera are typically pathogenic in humans. Of these, Streptococcus and Staphylococcus are cocci (sphere-shaped). The remaining organisms are bacilli (rod-shaped) and can be subdivided based on their ability to form spores. The non-spore formers are Corynebacterium and Listeria (a coccobacillus), whereas Bacillus and Clostridium produce spores. The spore-forming bacteria can again be divided based on their respiration: Bacillus is a facultative anaerobe, while Clostridium is an obligate anaerobe.
  • gram positivity is intended to reflect the fact that gram staining leads to a stained bacterium. It is not intended to be limited to bacteria that have certain physical membrane characteristics (in general, the following characteristics are present in grampositive bacteria: cytoplasmic lipid membrane; thick peptidoglycan layer; teichoic acids and lipoids are present, forming lipoteichoic acids, which serve as chelating agents, and also for certain types of adherence; peptidoglycan chains are cross-linked to form rigid cell walls by a bacterial enzyme DD-transpeptidase; a much smaller volume of periplasm than that in gram-negative bacteria; S- layer attached to the peptidoglycan layer; the presence of teichoic acids in the cell wall).
  • cytoplasmic lipid membrane thick peptidoglycan layer
  • teichoic acids and lipoids are present, forming lipoteichoic acids, which serve as chelating agents, and also for certain types of adherence
  • the invention also encompasses glycyclcyclines for treatment of pseudo-gram-positive bacteria.
  • mycobacteria have a particular cell wall, which is neither truly Gram negative nor positive.
  • mycobacteria stain gram positive, and are therefore encompassed by the invention.
  • the staining behaviour of species is generally known (see for instance Pfyffer GE, Palicova F. Mycobacterium: General characteristics, laboratory detection, and staining procedures. In: Vesalovic et al (Eds). Manual of Clinical Microbiology, 10th Edition. ASM Press, 201 1 . pp. 472- 502), and in any case can be ascertained by routine staining practice.
  • the invention provides the glycylcycline for use according to the invention, wherein the subject is infected with mycobacteria, preferably with nontuberculous mycobacteria.
  • Mycobacteria form a genus of Actinobacteria, the Mycobacteriaceae. This genus includes pathogens known to cause serious diseases in mammals, including tuberculosis (Mycobacterium tuberculosis) and leprosy ( Mycobacterium leprae) in humans.
  • Mycobacteria are generally acid fast, and can be subdivided in M.
  • tuberculosis complex mycobacteria that can cause tuberculosis or leprosy
  • nontuberculous mycobacteria the other mycobacteria, which can cause pulmonary disease resembling tuberculosis, lymphadenitis, skin disease, or disseminated disease
  • mycobacteria are nontuberculous mycobacteria, as good results have been achieved in treating these gram positive bacteria.
  • mycobacteria are gram positive mycobacteria.
  • the glycylcycline for use according to the invention wherein the subject is infected with a mycobacterium of a clade selected from the group consisting of M. abscessus, M. avium complex, M. tuberculosis complex, M. cheionae, M. fortuitum, M. mucogenicum, M. para fortuitum, M. simiae, M. kansasii, and M. peregrinum, preferably of the clade M. abscessus or M. avium complex.
  • Mycobacteria of the M. cheionae clade are preferably selected from M. cheionae, M.
  • Mycobacteria of the M. fortuitum clade are preferably selected from M. boenickei, M. brisbanense, M. cosmeticum, M. fortuitum, M. fortuitum subsp. acetamidolyticum, M. houstonense, M. mageritense, M. neworleansense, M. peregrinum, M. porcinum, M. senegalense, and M. septicum.
  • Mycobacteria of the M. mucogenicum clade are preferably selected from M. aubagnese, M. mucogenicum, and M. phocaicum. Mycobacteria of the M.
  • parafortuitum clade are preferably selected from M. austroafricanum, M. diernhoferi, M. frederiksbergense, M. hodleri, M. neoaurum, and M. parafortuitum.
  • Mycobacteria of the M. simiae clade are preferably selected from M. Horentinum, M. genavense, M. heidelbergense, M. interjectum, M. kubicae, M. lentiflavum, M. montefiorense, M. palustre, M. parascrofulaceum, M. simiae, and M. triplex. Mycobacteria of the M.
  • kansasii clade are preferably selected from M. gastri and M. kansasii.
  • Mycobacteria of the M. avium complex are preferably selected from M. avium, M. avium paratuberculosis (which has been implicated in Crohn's disease in humans and is the causative agent of Johne's disease in cattle and sheep), M. avium silvaticum, M. avium "hominissuis", M. avium avium, M. colombiense, M. indicus pranii, M. chimaera, M. vulneris, M. arosiense, M. occidentaldurhonense, M. timonense, M. marseillense, M.
  • M. abscessus clade are preferably selected from M. abscessus subspecies abscessus, M. abscessus subspecies bolletii or M. abscessus subspecies massiliense.
  • the glycylcycline for use according to the invention wherein the subject is infected with a mycobacterium of the clade M. abscessus, or a subspecies thereof such as M. abscessus subspecies abscessus, M. abscessus subspecies bolletii or M. abscessus subspecies massiliense.
  • a glycylcycline for use according to the invention is for use in the treatment of a subject infected with gram positive bacteria, wherein the glycylcycline is administered by inhalation.
  • treatment of a bacterial infection may refer to preventing, ameliorating, curing, and/or delaying an infection with gram positive bacteria.
  • Prevention of an infection may mean that an infection is cured before symptoms of the infection have manifested.
  • successful treatment may mean that:
  • Preferred symptoms are selected from the group consisting of epithelial destruction, redness, edema, haemorrhage, exudate, cough, sputum production, fatigue, weight loss, malaise, night sweats, fever, chest pain, decreased exercise tolerance, dyspnoea, and dizziness, more preferably selected from cough, sputum production, fatigue, weight loss, malaise, night sweats, and fever.
  • a parameter may be a symptom as described above, or it may preferably be selected from the group consisting of prolongation of patient survival, improvement of the quality of life, observed pain relief, amelioration of a comorbid condition, decrease in the number of live mycobacteria in respiratory samples measured by quantitative cultures, decrease in the number of live mycobacteria in respiratory samples measured by semi-quantitative cultures, decrease in the grade of sputum smear positivity by direct microscopy and auramine or Ziehl-Neelsen staining, no live mycobacteria detectable by culture in respiratory samples, improvement of lesions seen on computed tomography scans of the lungs, increase in forced expiratory volume in 1 second (FEV1) in pulmonary function testing, increased exercise tolerance, increased walking distance in the 6-minute walk test, and improvement in quality of life reported in St Georges Respiratory Questionnaire or optionally other quality of life measurement.
  • FEV1 forced expiratory volume in 1 second
  • a symptom is selected from the group consisting of prolongation of patient survival, decrease in the number of live mycobacteria in respiratory samples measured by quantitative cultures, decrease in the grade of sputum smear positivity by direct microscopy and auramine or Ziehl-Neelsen staining, no live mycobacteria detectable by culture in respiratory samples, improvement of lesions seen on computed tomography scans of the lungs, increase in forced expiratory volume in 1 second (FEV1) in pulmonary function testing, increased walking distance in the 6-minute walk test, and improvement in quality of life reported in St Georges Respiratory Questionnaire.
  • FEV1 forced expiratory volume in 1 second
  • treating, preventing, curing and/or delaying an infection is preferably assessed or detected after at least one day, two days, three days, four days, one week, two weeks, three weeks, four weeks, one month, two months, three months, four months, five months, six months or more in a treated subject.
  • Treating, preventing, curing and/or delaying an infection is preferably identified in a subject as:
  • a patient may survive and/or may be considered as being disease free. Alternatively, the infection may have been stopped or delayed.
  • an improvement of quality of life and observed pain relief may mean that a patient may need less pain relief drugs than at the onset of the treatment. Alternatively or in combination with the consumption of less pain relief drugs, a patient may be less short of breath than at the onset of the treatment.“Less” in this context may mean 5% less, 10% less, 20% less, 30% less, 40% less, 50% less, 60% less, 70% less, 80% less, 90% less. A patient may no longer need any pain relief drug or respiratory assistance.
  • This improvement of quality of life and observed pain relief may be seen, detected or assessed after at least one week, two weeks, three weeks, four weeks, one month, two months, three months, four months, five months, six months or more of treatment in a patient and compared to the quality of life and observed pain relief at the onset of the treatment of said patient.
  • the infection is an opportunistic infection.
  • the glycylcycline for use according to the invention wherein the subject is infected with a pulmonary infection.
  • Pulmonary infection can be any infection of the respiratory tract, including infections that contribute to tissue damage. This pulmonary infection is preferably by the gram positive bacteria described earlier herein.
  • Preferred pulmonary infections are upper respiratory tract infection such as nasal cavity infection, frontal sinus infection, maxillary sinus infection, pharynx infection, or larynx infection; and lower respiratory tract infection, such as tracheal infection, bronchial infection, endobronchial infection, bronchiectasis infection, bronchiolar infection, alveolar infection, lung parenchymal infection, and lung infection. Most preferred infections are bronchial infection, endobronchial infection, bronchiectasis infection, bronchiolar infection, alveolar infection, lung parenchymal infection, and lung infection.
  • a subject may be cured of all pulmonary infection.
  • the lungs of the subject have been sterilised.
  • at least part of the infecting gram positive bacteria are killed, more preferably all infecting gram positive bacteria are killed.
  • the reduction of micro-organisms is conventionally classified using a logarithmic scale.
  • a single log reduction is a 90% reduction of organisms, and is often referred to as a 1 log kill.
  • a two log reduction is a 99% reduction of organisms, referred to as a 2 log kill, followed by a three log reduction (99.9%, referred to as 3 log kill), etc.
  • the treatment has at least 1 log kill efficacy.
  • the glycylcycline for use according to the invention wherein the treatment has at least 2 log kill efficacy. More preferably, the treatment has 3 log kill efficacy.
  • the treatment has 3.5 log kill efficacy, more preferably still 4 log kill efficacy, even more preferably still 4.5 log kill efficacy, most preferably 5 log kill efficacy.
  • Log kill efficacy can be determined using techniques known in the art, for example by bacteria count or CFU determination, preferably as described in the examples.
  • Efficacy is preferably assessed after 1 week of treatment, more preferably after 2, 3, 4, 5, 6, 7, 8, 9, 10, 1 1 , or 12 weeks of treatment, even more preferably after 4 weeks of treatment.
  • Such treatment preferably involves administration by inhalation 4, 3, 2, or 1 times per day, or 7, 6, 5, 4, 3, 2, or 1 times per week.
  • efficacy is assessed by culture such as sputum culture after at least four weeks and preferably after at least eight weeks of treatment wherein treatment consisted of daily administration of at least 1 .25 mg glycylcycline for use according to the invention, more preferably as exemplified in Example 1 .
  • Sputum culture as described herein is preferably sputum culture using Middlebrook 7H9 liquid medium, Middlebrook 7H10 solid medium, Middlebrook 7H1 1 solid medium, Ogawa solid medium, Coletsos solid medium, Stonebrink solid medium, or Lowenstein-Jensen solid medium, optionally with other terms and definitions preferably as described in Example 1 .
  • efficacy is classified using smear microscopy with subsequent grading (1 +, 2+, 3+, 4+).
  • sputum samples are analysed by direct microscopy with Ziehl- Neelsen staining or auramine staining to visualize the bacteria.
  • the density of mycobacteria is assessed by the number of mycobacteria seen per visual field and graded based thereupon, applying the World Health Organisation-approved grading system (WHO reference number: WHO/HTM/TB/2015.1 1 ).
  • efficacy is classified using semi-quantitative culture, preferably sputum culture, measuring time-to-positivity.
  • semi-quantitative culture preferably sputum culture
  • time-to-positivity is a marker for the number of viable bacteria present in the clinical sample.
  • Successful treatment preferably reduces the amount of live bacteria.
  • the glycylcycline according to the invention does not cause adverse effects.
  • Treatment using glycylcycline for use according to the invention preferably comprises administration 6 times per day, more preferably 5, 4, 3, 2, or 1 time per day, even more preferably 1 time per day. In further preferred embodiments, administration is less than one time per day such as 6, 5, 4, 3, 2, or 1 times per week.
  • Treatment using glycylcycline for use according to the invention preferably comprises administration of at least 0.5 mg of glycylcycline, more preferably at least 1 , 1 .5, 2, 2.5, 3, 3.5, 4, 4.5, 5, 5.5, 6, 6.5, 7, 7.5, 8, 8.5, 9, 9.5, 10, 1 1 , 12, 13, 14, 15, 16, 17, 18, 19, 20, 21 , 22, 23 ,24, 25, 30, 35, 40, 45, 50, 60, 70, 80, 90, 100, 1 10, 120, 130, 140, 150, 160, 170, 180, 190, or 200 mg per administration, even more preferably at least 10 mg, more preferably still at least 50 mg, even more preferably 60 mg, more preferably 70 mg, more preferably still 80 mg, even more preferably at least 100 mg, more preferably still at least 125 mg, most preferably at least 150 mg per administration.
  • treatment using glycylcycline for use according to the invention preferably comprises administration of at least 300 mg of glycylcycline, more preferably at least 400, even more preferably at least 500 mg, most preferably at least 600 mg.
  • Treatment using glycylcycline for use according to the invention preferably comprises administration of at most 1000 mg of glycylcycline, more preferably at most 900, 800, 700, 600, 500, 400, 350, 300, 250, 240, 230, 220, 210, 200, 190, 180, 170, 160, 150, 140, 130, 120, 1 10, or 100 mg per administration, even more preferably at most 600 mg, more preferably still at most 500 mg, even more preferably still at most 400 mg, even more preferably 200 mg, more preferably still at most 150 mg, even more preferably at most 140 mg, more preferably 130 mg, more preferably still 120 mg, more preferably still 1 10 mg, even more preferably at most 100 mg, more preferably 90 mg, more preferably still at most 80 mg, most preferably at most 75 mg per administration.
  • the glycylcycline for use according to the invention wherein less than 400 mg/day is administered to a subject, preferably less than 200 mg/day, more preferably less than 100 mg/day. Mention of a dose per administration is preferably the dose that is administered in a single inhalation or in a single consecutive series of inhalation, preferably in a single inhalation. In other preferred embodiments a dose is the total cumulative dose that is administered over one day.
  • the glycylcycline for use according to the invention wherein the subject is suffering from a disease selected from the group consisting of cystic fibrosis, non-cystic fibrosis bronchiectasis, pneumonia (such as preferably hospital-acquired pneumonia or ventilator-acquired pneumonia), chronic pulmonary obstructive disease, nontuberculous mycobacteria (NTM) pulmonary infection, and tuberculosis, preferably cystic fibrosis.
  • cystic fibrosis also known as CF, mucovoidosis or mucoviscidosis, is a fatal genetic disorder.
  • cystic fibrosis is ranked as one of the most widespread life-shortening genetic diseases and it affects more than 60,000 people worldwide. It is associated with impairment in the transport of chloride ions across the epithelial membranes of exocrine glands, which causes a decreased water content of their secretions. Morphological changes of dilation and hypertrophy of the bronchial glands are followed by mucous plugging. Said viscid mucus in the airways allows bacterial colonization, with consequent infection of the respiratory tract, contributing to ongoing tissue damage. Haemophilus influenza and Staphylococcus aureus are the first pathogens that colonize the airway in childhood.
  • Nontuberculous mycobacteria are increasingly recognized as causative agents of such opportunistic infections in humans. Pulmonary infections are most frequent. Mycobacterium avium complex and Mycobacterium abscessus cause 70% and 20% of these pulmonary infections, depending on geographical location. Mycobacterium abscessus specifically infects patients with Cystic Fibrosis.
  • the glycylcycline for use according to the invention is for treating infection with Mycobacterium abscessus in a subject suffering from cystic fibrosis. In preferred embodiments the glycylcycline for use according to the invention is for treating infection in a subject suffering from hospital-acquired pneumonia or ventilator-acquired pneumonia.
  • the glycylcycline for use according to the invention is for preventing infection by gram positive bacteria, preferably by mycobacteria. Such prevention is preferably in subjects suffering from cystic fibrosis, or in subjects who have recently been cured from an infection, preferably from a gram positive bacterial infection such as a pulmonary gram positive bacterial infection, more preferably from a mycobacterial pulmonary infection.
  • Treatment as described herein is advantageously combined with further treatment, for example in multi-drug regimens.
  • multi-drug regimens comprise simultaneous or sequential administration of at least two different drugs. This helps prevent the rise of drug resistance in bacteria (Lee et al., J. Pharm. Sci., 2016, DOI: 10.1016/j.xphs.2016.02.007).
  • the glycylcycline for use according to the invention wherein administration of the glycylcycline is part of a multi-drug regimen for the treatment of the bacterial infection.
  • Preferred multi-drug regimens involve further use of colistin, meropenem, aminoglycosides such as tobramycin, or rifampicin, preferably of at least two of colistin, meropenem, aminoglycosides, or rifampicin.
  • Other preferred multi-drug regimens involve further use of imipenem, cefoxitin, aminoglycosides such as amikacin, macrolides such as azithromycin and clarithromycin or clofazimine, preferably of at least two of imipenem, cefoxitin, aminoglycosides, or macrolides.
  • the invention provides a method of treating, preventing, or delaying infection with gram positive bacteria in a subject in need thereof, the method comprising the step of administering glycylcycline to the subject via inhalation.
  • an effective amount is administered, which is an amount that provides a beneficial effect. More features and definitions have been provided elsewhere herein.
  • Treatment as described herein can be understood as the manufacture of a medicament for treatment of the indicated condition.
  • the glycylcycline for use according to the invention is administered by inhalation, and is therefore preferably formulated for inhalation.
  • Administration of particles by inhalation to the respiratory system can be by means such as known in the art.
  • particles or agglomerates can be delivered from an inhalation device.
  • particles are administered via a dry powder inhaler (DPI).
  • DPI dry powder inhaler
  • MDI Metered-dose-inhalers
  • aerosol spray inhalers aerosol spray inhalers
  • nebulizers or instillation techniques also can be employed.
  • delivery is to the bronchioli and alveoli region of the pulmonary system, the central airways, or the upper airways, most preferably to bronchiole, lung tissue and alveolar macrophages.
  • suitable inhalers are described in US4995385, US4069819, and US5997848.
  • Other examples include, but are not limited to, the Spinhaler(R) (Fisons, Loughborough, U.K.), Rotahaler(R) (Glaxo-Wellcome, Research Triangle Technology Park, North Carolina), FlowCaps(R) (Hovione, Loures, Portugal), Inhalator.RTM.
  • the formulations are administered as a dry powder via a dry powder inhaler.
  • the dry powder inhaler is a simple, breath actuated device.
  • An example of a suitable inhaler which can be employed is described in US6766799.
  • a receptacle is used to enclose or store particles and/or respirable pharmaceutical compositions comprising the particles for subsequent administration.
  • the receptacle is filled with the particles using methods as known in the art. For example, vacuum filling or tamping technologies may be used. Generally, filling the receptacle with the particles can be carried out by methods known in the art.
  • the particles that are enclosed or stored in a receptacle have a mass of at least about 5 milligrams up to about 100 milligrams, in another embodiment, the mass of the particles stored or enclosed in the receptacle comprises a mass of bioactive agent from at least about 1 .5 mg to at least about 20 milligrams.
  • the volume of the inhaler receptacle is at least about 0.37 cm 3 to 0.95 cm 3 .
  • the receptacles can be capsules or blisters. Suitable capsules can be obtained, for example, from Shionogi (Rockville, Md.). ;Blisters can be obtained, for example, from Hueck Foils, (Wall, N.J.).
  • particles administered to the respiratory tract travel through the upper airways (oropharynx and larynx), the lower airways which include the trachea followed by bifurcations into the bronchi and bronchioli and through the terminal bronchioli which in turn divide into respiratory bronchioli leading then to the ultimate respiratory zone, the alveoli orthe deep lung.
  • most of the mass of particles deposits in the deep lung.
  • delivery is primarily to the central airways. Delivery to the upper airways can also be obtained.
  • Aerosol dosage, formulations and delivery systems also may be selected for a particular therapeutic application, as described, for example, in Gonda, I. "Aerosols for delivery of therapeutic and diagnostic agents to the respiratory tract," in Critical Reviews in Therapeutic Drug Carrier Systems, 6: 273-313, 1990; and in Moren, "Aerosol dosage forms and formulations,” in: Aerosols in Medicine. Principles, Diagnosis and Therapy, Moren et al., Eds, Elsevier, Amsterdam, 1985.
  • the glycylcycline for use according to the invention is preferably comprised in a composition.
  • the glycylcycline for use according to the invention wherein the glycylcycline is formulated as an inhalable formulation that further comprises a pharmaceutically acceptable excipient such as a lubricant, preferably a stearate.
  • a pharmaceutically acceptable excipient such as a lubricant, preferably a stearate.
  • a preferred stearate is a stearate salt of a bivalent pharmaceutically acceptable metal ion such as magnesium.
  • the glycylcycline for use according to the invention wherein the inhalable formulation comprises at least 1 wt.-%, preferably at least 10 wt.-%, more preferably at least 80 wt.-% of glycylcycline. More preferably, at least 90, 95, 96, 97, 98, or 99 wt.- % is comprised.
  • the glycylcycline for use according to the invention wherein the formulation further comprises additional pharmaceutically active agents, preferably further antibiotics, more preferably at least one agent selected from colistin, meropenem, aminoglycosides such as tobramycin, or rifampicin, preferably of at least two of colistin, meropenem, aminoglycosides, or rifampicin.
  • additional pharmaceutically active agents preferably further antibiotics, more preferably at least one agent selected from colistin, meropenem, aminoglycosides such as tobramycin, or rifampicin, preferably of at least two of colistin, meropenem, aminoglycosides, or rifampicin.
  • the glycylcycline for use according to the invention wherein the glycylcycline is formulated for nebulisation or for dry powder inhalation, preferably for nebulisation.
  • the glycylcycline is formulated as a dry powder formulation for pulmonary administration, such as granulated drug powder, liposomal formulation, or mechano- fused microparticles.
  • Preferred forms comprise mechano-fused microparticles consisting of particles of glycylcycline in an amount comprised between 98 and 99.9% w/w and a lubricant such as magnesium stearate in an amount comprised between 0.1 and 2% w/w, said lubricant (preferably magnesium stearate) forming a coating of the whole surface of the drug particles for at least 50%, wherein at least 90% of said microparticles have a volume diameter lower than about 10 micron, said microparticles being obtainable by a mechano-fusion process.
  • WO201 1073002 describes suitable methods for preparing coated particles by such a process.
  • the term "coat” preferably means that a lubricant such as magnesium stearate forms a film around the active particles. The coating is only partial when the amount of lubricant is not sufficient for forming a film around the whole surface of all the particles of the active ingredient.
  • Mechano-fused microparticles may be crystalline or amorphous.
  • the percentage of amorphicity expressed as weight percent with respect to the total weight of the microparticles, may greatly vary and it may be equal to or higher than 50%, preferably of at least 70%, even more preferably of at least 90%. Said percentage of amorphicity may be determined using X-ray powder diffraction or other known techniques known to the skilled person such as differential scanning calorimelry (DSC) or microcalorimetry.
  • DSC differential scanning calorimelry
  • the glycylcycline is in a liposomal formulation.
  • the liposomal formulation preferably is formed into respirable aggregates for administration by inhalation. Any liposomal formulation technique known in the art may be used.
  • Liposomal formulations which may be utilized may include a glycylcycline prepared as a first phase, optionally in combination with a solubilizer, while a second phase is prepared containing at least one phospholipid. The two phases may be combined, thereby forming liposomes comprising the glycylcycline. As noted above, these liposomes may then be formed into respirable aggregates and administered by inhalation.
  • a composition of the present disclosure may include at least one respirable aggregate including a liposome comprising a glycylcycline; and, at least one phospholipid such as lecithin, lysolecithin, phosphatidylcholine, phosphatidylethanolamine, phosphatidylinositol, phosphatidylglycerol, phosphatidic acid, phosphatidylserine, lysophosphatidylcholine, lysophosphatidylethanolamine, lysophosphatidylglycerol, lysophosphatidic acid, lysophosphatidylserine, PEG- phosphatidylethanolamine, PVP-phosphatidylethanolamine, and combinations thereof, wherein the respirable aggregate has a mass median aerodynamic diameter of from about 1 pm to about 5 pm.
  • the respirable aggregate has a mass median aerodynamic diameter of from about 1 pm to about 5 pm.
  • a method may include preparing a first phase including a glycylcycline, optionally in combination with a solubilizer; preparing a second phase including at least one phospholipid; contacting the first phase with the second phase to form liposomes comprising the glycylcycline; recovering the liposomes; and forming the liposomes into respirable aggregates having a mass median aerodynamic diameter of from about 1 pm to about 5 pm.
  • Inhalable formulations can be formulated for nebulisation, preferably for administration using a nebulizer.
  • a nebulizer is well known in the art, and is a drug delivery device used to administer medication in the form of a mist inhaled into the lungs. Nebulizers are commonly used for the treatment of cystic fibrosis.
  • the lung deposition characteristics and efficacy of a generated aerosol depends largely on the particle or droplet size. Generally, the smallerthe particle the greater its chance of peripheral penetration and retention. However, for very fine particles below 0.5 pm in diameter there is a chance of avoiding deposition altogether and being exhaled.
  • particles of more than 10 pm in diameter are most likely to deposit in the mouth and throat, for those of 5- 10 pm diameter a transition from mouth to airway deposition occurs, and particles smaller than 5 pm in diameter deposit more frequently in the lower airways and are highly appropriate for pharmaceutical aerosols.
  • Suitable nebulisers and excipients for formulations for nebulisation according to this invention are disclosed in US2017296562.
  • the particle size of particles is quantified by measuring a characteristic equivalent sphere diameter, known as volume diameter, by laser diffraction.
  • the particle size can also be quantified by measuring the mass diameter by means of suitable instruments well known to the skilled person.
  • the volume diameter (V D) is related to the mass diameter (MD) by the density of the particles (assuming a size independent density for the particles).
  • the term "mechano-fused" refers to microparticles constituted of two different materials wherein a first material is mechanically fused onto a second by a dry process.
  • Particle size is preferably expressed in terms of volume diameter and the particle size distribution is expressed in terms of: i) the volume median diameter (VMD) which corresponds to the diameter of 50 percent by weight or volume respectively, of the particles, and ii) the volume diameter (VD) in micron of 10% and 90% of the particles, respectively.
  • VMD volume median diameter
  • Particles can be "agglomerated", which is used herein with two different meanings.
  • agglomerated microparticles refers to particles which consist of more than one microparticles, those microparticles being adhered to each other.
  • an agglomerated microparticle of of 1 .5 micron may consist of a large number of microparticles each having a lower diameter, adhered together.
  • loose-agglomerated microparticles refers to particles in form of soft agglomerates which could easily break-up to give rise to the single microparticles.
  • Formulations particularly dry powder formulations, preferably have suitable flow properties.
  • suitable flow properties refers to a formulation that is easy handled during the manufacturing process and is able of ensuring an accurate and reproducible delivering of the therapeutically effective dose.
  • accurate therapeutically active dose of the active ingredient refers to a formulation wherein, upon actuation, the mean emitted dose is equal to or higher than 60% of the nominal dose, preferably higher than 65%, even more preferably higher than 70%.
  • Formulations are preferably chemically stable and/or physically stable.
  • chemically stable refers to a formulation that, upon storage, meets the requirements of the EMEA Guideline CPMP/QWP/122/02 referring to "Stability Testing of Existing Active Substances and Related Finished Products”.
  • physically stable refers to a formulation that does not change its physical state in the device before use and upon storage.
  • respirable fraction refers to an index of the percentage of active particles which would reach the deep lungs in a patient.
  • the respirable fraction also termed fine particle fraction (FPF)
  • a suitable in vitro apparatus typically the Multistage Cascade Impactor or Multi Stage Liquid Impinger (MLSI) according to procedures reported in common Pharmacopoeias.
  • MLSI Multi Stage Liquid Impinger
  • Twin Stage Apparatus may be advantageously used.
  • therapeutically effective amount preferably means the amount of the glycylcycline, that, when delivered to the lungs via a formulation such as a dry powder formulation as described herein, provides the desired biological effect.
  • the glycylcycline for use according to the invention wherein the inhalable formulation comprises glycylcycline microparticles having a volume diameter lower than 15 pm, preferably lower than 10 pm.
  • the particle size of the microparticles of the invention is preferably lower than 15 micron.
  • at least 90% of the particles have a volume diameter lower than about 10 micron.
  • no more than 10% of the microparticles have a volume diameter lower than 0.1 micron.
  • no more than 50% of particles have a volume diameter lower than 0.6, and preferably it is comprised between 0.7 and 2.0 micron, more preferably between 0.8 and 1.5 micron.
  • Particle size can be measured by laser diffraction according to known methods.
  • Microparticles and mechano-fused microparticles of the invention may be present in the form of unagglomerated, e.g., individual, or stable agglomerated microparticles, those stable agglomerated microparticles having a particle size comprised in one of the ranges described above.
  • the microparticles of the invention exhibit a very low amount of residual water, e.g. preferably lower than 5.0% w/w, more preferably comprised between 4.8% and 4.5% w/w, as determined according to known methods such as the Karl-Fisher method.
  • the invention also provides a capsule for use with a dry powder inhaler filled with the glycylcycline for use according to the invention, or with a formulation as described herein. Dry powder inhalers can be divided into two basic types:
  • each single dose is usually filled in a capsule;
  • Glycylcyclines are a class of antibacterial agents that is known in the art. They feature a carbocyclic skeleton that is also present in the tetracyclines that is necessary for antibacterial activity. In glycylcyclines, substitution of an N-alkyl-glycylamido group on the D ring at the 9th position facilitates the broader spectrum of activity (Sum et al., J. Med. Chem. 1994, 37, 184-188).
  • the glycylcycline is of general formula 1 :
  • Q 1 , Q 2 , Q 3 , and Q 4 are each independently chosen from -H, -CH3, and -OH;
  • R 1 and R 2 are each independently chosen from H or C1-6 hydrocarbon, or R 1 and R 2 together with the N to which they are attached form a 3- to 7-membered cyclic structure;
  • X is selected from -H, -halogen, or -N(R 11 )(R 22 );
  • R 11 and R 22 are each independently chosen from H or C1-6 hydrocarbon, or R 11 and R 22 together with the N to which they are attached form a 3- to 7-membered cyclic structure. More preferably, the glycylcycline is of general formula 1 a:
  • Q 1 , Q 2 , Q 3 , and Q 4 are each independently chosen from -H, -CH3, and -OH; in preferred embodiments, Q 3 and Q 4 are -H; in more preferred embodiments, Q 1 is -OH or -H, Q 2 is -CH3 or - H, Q 3 is -H or -OH, and Q 4 is -H; in even more preferred embodiments, each of Q 1 , Q 2 , Q 3 , and Q 4 are -H, or Q 1 is -OH, Q 2 is -CH 3 , Q 3 is -H, and Q 4 is -H, or Q 1 is -H, Q 2 is -CH 3 , Q 3 is -OH, and Q 4 is -H; when any of Q 1 , Q 2 , Q 3 , or Q 4 is not -H, X is preferably H; in highly preferred embodiments, each of Q 1 , Q 2 , Q 3 , and Q 4 are -H; such a gly
  • R 1 and R 2 are each independently chosen from H or C1-6 hydrocarbon, or R 1 and R 2 together with the N to which they are attached form a 3- to 7-membered cyclic structure;
  • X is selected from -H, -halogen, or -N(R 11 )(R 22 );
  • R 11 and R 22 are each independently chosen from H or C1-6 hydrocarbon, or R 11 and R 22 together with the N to which they are attached form a 3- to 7-membered cyclic structure. It is highly preferable that for glycylcyclines of general formula 2 the stereochemistry is as in general formula 2a:
  • R 1 and R 2 are each independently chosen from H or Ci-e hydrocarbon, or R 1 and R 2 together with the N to which they are attached form a 3- to 7-membered cyclic structure.
  • Ci-e hydrocarbon can be unsaturated, and is preferably selected from Ci-e alkyl, C2-6 alkenyl, and C2-6 alkynyl.
  • C1-6 alkyl is an even more preferred C1-6 hydrocarbon and can be methyl, ethyl, n-propyl, isopropyl, cyclopropyl, n-butyl, sec-butyl, ferf-butyl, isobutyl, cyclobutyl, n-pentyl, ferf-pentyl, neopentyl, pentan-2-yl, pentan-3-yl, sec-isopentyl, 2-methylbutyl, and 3-methylbutyl, cyclopentyl, n-hexyl, and cyclohexyl.
  • the C1-6 hydrocarbon is a C1-4 alkyl.
  • R 1 and R 2 can form a cyclic structure with the N to which they are connected. In preferred embodiments this cyclic structure is 4, 5, or 6-membered, most preferably it is 5-membered, forming a pyrrolyl moiety. In preferred embodiments, R 1 and R 2 are both methyl, or R 1 and R 2 together form a 3- to 7-membered cyclic structure that is preferably pyrrolyl, or R 1 is H and R 2 is C4 alkyl that is preferably ferf-butyl. Most preferably R 1 is H and R 2 is ferf-butyl.
  • X is selected from -H, -halogen, or -N(R 11 )(R 22 ); when any of Q 1 , Q 2 , Q 3 , or Q 4 is not -H, X is preferably H; when X is -halogen, it is preferably -F; when each of Q 1 , Q 2 , Q 3 , or Q 4 is-H, X is preferably halogen or -N(R 11 )(R 22 ), more preferably -F or -Cl or -N(R 11 )(R 22 ), even more preferably -F or -N(R 11 )(R 22 ), most preferably -N(R 11 )(R 22 ).
  • X is preferably halogen or -N(R 11 )(R 22 ), more preferably -F or -Cl or -N(R 11 )(R 22 ), even more preferably -F or -N(R 11 )(R 22 ), most preferably - N(R 11 )(R 22 ).
  • R 11 and R 22 are each independently chosen from H or C1-6 hydrocarbon, or R 11 and R 22 together with the N to which they are attached form a 3- to 7-membered cyclic structure.
  • C1-6 hydrocarbon can be unsaturated, and is preferably selected from C1-6 alkyl, C2-6 alkenyl, and C2-6 alkynyl.
  • Ci-e alkyl is an even more preferred Ci-e hydrocarbon and can be methyl, ethyl, n-propyl, isopropyl, cyclopropyl, n-butyl, sec-butyl, te/ -butyl, isobutyl, cyclobutyl, n-pentyl, te/ -pentyl, neopentyl, pentan-2-yl, pentan-3-yl, sec-isopentyl, 2-methylbutyl, and 3-methylbutyl, cyclopentyl, n- hexyl, and cyclohexyl.
  • the Ci-e hydrocarbon is a C 1-4 alkyl.
  • R 1 1 and R 22 can form a cyclic structure with the N to which they are connected. In preferred embodiments this cyclic structure is 4, 5, or 6-membered, most preferably it is 5-membered, forming a pyrrolyl moiety.
  • R 1 1 and R 22 are both methyl, or R 1 1 and R 22 together form a 3- to 7- membered cyclic structure that is preferably pyrrolyl, or R 1 1 is H and R 22 is C4 alkyl that is preferably ferf-butyl. Most preferably, R 1 1 and R 22 are both methyl.
  • halogen is selected from F, Cl, or Br, more preferably from F or
  • halogen is F.
  • the glycylcycline is selected from the group consisting of tigecycline, eravacycline, DMG-DMDOT, DMG-MINO, and DMG-DOXY, more preferably selected from the group consisting of tigecycline, eravacycline, DMG-DMDOT, and DMG-MINO. Most preferably the glycylcycline is tigecycline. Accordingly, in preferred embodiments is provided the glycylcycline for use according to the invention, wherein the glycylcycline is tigecycline. These preferred glycylcyclines are shown below with their structures above their names.
  • glycylcyclines Synthesis of glycylcyclines is known from EP0582790, US5494903, and Sum et al., J. Med. Chem. 1994, 37, 184-188, amongst various other sources.
  • an aminomethylcycline is used instead of a glycylcycline.
  • Aminomethylcyclines are known in the art, and preferred aminomethylcyclines are the compounds of which the molecular structures are shown in tables 2 and 3 of Honeyman et al., Antimicrob. Agents Chemother., 2015 (59):1 1 . 7044-7053 (DOI:10.1 128/AAC.01536-15 ).
  • aminomethylcyclines share a close structural relationship with glycylcyclines.
  • the mechanism of action of aminomethylcyclines is similar to that of other tetracyclines and glycylcyclines, namely inhibition of bacterial protein synthesis. They share activity against bacterial strains expressing the two main forms of tetracycline resistance (efflux and ribosomal protection, see Draper et al., Antimicrob. Agents Chemother. 58 (3): 1279-1283. doi:10.1 128/AAC.01066-13).
  • aminomethylcyclines against mycobacteria Activity of aminomethylcyclines against mycobacteria is known (Shoen et al., 2019, Antimicrob. Agents Chemother., DOI: 10.1 128/AAC.02522- 18 ; Kaushik et al., 2019, Antimicrob. Agents Chemother., DOI: 10.1 128/AAC.00470-19 which also demonstrates Eravacycline activity). More preferred aminomethylcyclines are compounds 4, 6, 26, 8, 27, 28, 29, 9, 30, 31 , 23, 32, 33, 7, 34, 35, 36, 10, 37, 38, 1 1 , 39, 40, 41 , and 42 in table 3 of Honeyman et al., cited above. A most preferred aminomethylcycline is omadacycline (CAS: 389139-89-3 , compound 27 of Honeyman et al.)
  • a decrease or increase of a parameter to be assessed means a change of at least 5% of the value corresponding to that parameter. More preferably, a decrease or increase of the value means a change of at least 10%, even more preferably at least 20%, at least 30%, at least 40%, at least 50%, at least 70%, at least 90%, or 100%. In this latter case, it can be the case that there is no longer a detectable value associated with the parameter.
  • a cell or a sample can be a cell or a sample from a sample obtained from a subject.
  • Such an obtained sample can be a sample that has been previously obtained from a subject.
  • Such a sample can be obtained from a human subject.
  • Such a sample can be obtained from a non-human subject.
  • GM-CSF KO mice were infected through the intrapulmonary aerosol route using 1x10 6 cfu/50ul_ of M. abscessus. Bacteria were delivered in a saline solution as 50pl_ doses via an FMJ-250 high-pressure syringe device (PennCentury) with an attached MicroSprayer (MicroSprayer, model IA-C; PennCentury, Philadelphia, PA, USA).
  • CFU colony forming units
  • Tigecycline was reconstituted in 300pl_ of 0.9% endotoxin-free saline solution (TekNova) immediately before administration as to maximize bactericidal effects, and the mice received the dose variant TGC via intrapulmonary aerosol delivery using the same MicroSprayer device and methodology described above. All of the treatment groups (5 mice per group) received one 50pL dose 5 days a week for 4 consecutive weeks. Tigecycline was administered in three different doses, amounting to 2.5 mg/dose (2 groups, i.e. 10 mice in total), 1.25 mg/dose and 0.25 mg/dose.
  • mice were sacrificed and the lungs were removed for CFU determination on Middlebrook 7H11 media supplemented with OADC, carbenicillin, and cycloheximide. The result of CFU counts are presented in Table 1.
  • Table 1 Mycobacterium abscessus CFU counts after 4 weeks of inhaled tigecycline treatment

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Abstract

La présente invention concerne un nouveau régime d'administration de glycylcyclines. On a découvert que l'inhalation de ces antibiotiques permet de traiter de façon puissante une infection par des microbes mycobactériens tels que Mycobacterium abscessus.
PCT/EP2020/064444 2019-05-24 2020-05-25 Administration améliorée de glycylcyclines par inhalation WO2020239696A1 (fr)

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IT202100031133A1 (it) 2021-12-13 2023-06-13 Zambon Spa Composizione farmaceutica comprendente tigeciclina
WO2023110739A1 (fr) 2021-12-13 2023-06-22 Zambon S.P.A. Composition pharmaceutique comprenant de la tigécycline

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